Treatment

Treatment is determined by age, upper vs lower UTI and clinical condition.

Infants less than 3 months

NICE recommends that children under 3 months should be referred to paediatrics for IV antibiotics. Initial antibiotic therapy for infants under 3 months with fever is a third generation cephalosporin together with an antibiotic with listeria coverage (e.g. ceftriaxone and amoxicillin) [4, 6].

Infants and children older than 3 months

With bacteuria (demonstrated by a positive leukocytres/nitrites on dipstick), and either;
• Fever >38°C or
• Loin pain/tenderness
= Treat as pyelonephritis/upper UTI [1]

With bacteriuria(demonstrated by a positive leukocytres/nitrites on dipstick) with;
• No systemic symptoms or signs
= Treat as cystitis/lower UTI [1]

Learning Point:

Do not use CRP to differentiate between pyelonephritis and cystitis

Antibiotic Choice

Consider allergies, recent antibiotic use, previous urine MC&S results and local microbiology guidance when prescribing.

Pyelonephritis if; [6]
• Sepsis/severely unwell
• Vomiting/unable to take oral medications
IV antibiotics e.g. Cefuroxime, ceftriaxone, co-amoxiclav, gentamicin

Pyelonephritis – otherwise; [6]
Oral antibiotic for 7-10 days e.g. cefalexin, co-amoxiclav

Cystitis[7]
Oral antibiotic for 3 days e.g. trimethoprim, nitrofurantoin

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